Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT - A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party
Por:
Penack, O, Peczynski, C, van der Werf, S, Finke, J, Ganser, A, Schoemans, H, Pavlu, J, Niittyvuopio, R, Schroyens, W, Kaynar, L, Blau, IW, van der Velden, WJFM, Sierra, J, Cortelezzi, A, Wulf, G, Turlure, P, Rovira, M, Ozkurt, Z, Pascual-Cascon, MJ, Moreira, MC, Clausen, J, Greinix, H, Duarte, RF, Basak, GW
Publicada:
15 abr 2020
Resumen:
Elevated serum ferritin levels occur due to iron overload or during inflammation and macrophage activation. A correlation of high serum ferritin levels with increased mortality after alloSCT has been suggested by several retrospective analyses as well as by two smaller prospective studies. This prospective multicentric study aimed to study the association of ferritin serum levels before start of conditioning with alloSCT outcome. Patients with acute leukemia, lymphoma or MDS receiving a matched sibling alloSCT for the first time were considered for inclusion, regardless of conditioning. A comparison of outcomes between patients with high and low ferritin level was performed using univariate analysis and multivariate analysis using cause-specific Cox model. Twenty centers reported data on 298 alloSCT recipients. The ferritin cut off point was determined at 1500 mu g/l (median of measured ferritin levels). In alloSCT recipients with ferritin levels above cut off measured before the start of conditioning, overall survival (HR = 2.5, CI = 1.5-4.1, p = 0.0005) and progression-free survival (HR = 2.4, CI = 1.6-3.8, p < 0.0001) were inferior. Excess mortality in the high ferritin group was due to both higher relapse incidence (HR = 2.2, CI = 1.2-3.8, p = 0.007) and increased non-relapse mortality (NRM) (HR = 3.1, CI = 1.5-6.4, p = 0.002). NRM was driven by significantly higher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6-9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.
Filiaciones:
Penack, O:
Charite Univ Med Berlin, Dept Hematol Oncol & Tumor Immunol, Berlin, Germany
Peczynski, C:
EBMT Stat Unit, Paris, France
van der Werf, S:
EBMT Data Off, Leiden, Netherlands
Finke, J:
Univ Freiburg, Fac Med, Med Ctr, Dept Med 1, Freiburg, Germany
Ganser, A:
Hannover Med Sch, Hannover, NH, Germany
Schoemans, H:
Katholieke Univ Leuven, Univ Hosp Leuven, Dept Hematol, Leuven, Belgium
Pavlu, J:
Imperial Coll London, London, England
Niittyvuopio, R:
HUCH Comprehens Canc Ctr, Helsinki, Finland
Schroyens, W:
Antwerp Univ Hosp, Antwerp, Belgium
Kaynar, L:
Erciyes Univ, Med Fac, Kayseri, Turkey
Blau, IW:
Charite Univ Med Berlin, Dept Hematol Oncol & Tumor Immunol, Berlin, Germany
van der Velden, WJFM:
Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands
Sierra, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Cortelezzi, A:
Univ Milan, Fdn IRCCS Ca Granda, Milan, Italy
Wulf, G:
Univ Klinikum Gottingen, Dept Hematol & Med Oncol, Gottingen, Germany
Turlure, P:
CHRU Limoges, Limoges, France
Rovira, M:
Hosp Clin Barcelona, Barcelona, Spain
Ozkurt, Z:
Gazi Univ, Fac Med, Ankara, Turkey
Pascual-Cascon, MJ:
Hosp Reg Malaga, Malaga, Spain
Moreira, MC:
Inst Natl Canc, Rio De Janeiro, Brazil
Clausen, J:
Elisabethinen Hosp, Linz, Austria
Greinix, H:
Med Univ Graz, Dept Hematol & Oncol, Graz, Austria
Duarte, RF:
Hosp Univ Puerta Hierro, Madrid, Spain
Basak, GW:
Med Univ Warsaw, Dept Hematol & Oncol, Warsaw, Poland
Gold, Green Published
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